Midwest Oral and Maxillofacial Surgery P C
NPI #1467507798 in Columbia City, Indiana
Provider Information
- NPI Number
- 1467507798
- Entity Type
- Organization
- Organization Name
- Midwest Oral and Maxillofacial Surgery P C
- Primary Specialty
- Dentist - Oral and Maxillofacial Surgery
- Enumeration Date
- Jan 25, 2007
- Last Updated
- Mar 26, 2009
Practice Location
- Address
- 516 N LINE ST
- City
- Columbia City
- State
- Indiana
- ZIP Code
- 46725-1230
- Phone
- (260) 244-4007
Authorized Official
- Name
- DR. MICHAEL L ICZKOVITZ, DDS
- Title
- PRESIDENT
- Phone
- (260) 484-9990
Specialties & Taxonomy Codes
| Specialty |
|---|
| Dentist - Oral and Maxillofacial Surgery — Oral and Maxillofacial Surgery |
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